Climate change is harming human health with disproportionate impacts on vulnerable populations. As extreme weather events are projected to increase, acute care services the primary access point for patients during a disaster will be increasingly stressed. The authors seek to assess current efforts to build resilience against climate-related events in emergency units in low- and middle-income countries (LMICs). A systematic review was done using Ovid Medline, Embase, Cochrane, and Global Health (CABI), combining LMICs, climate change, emergency care, and resilience terms. LMIC emergency units serve as a ground zero during times of disaster, yet countries have a myriad of emergency care systems, with varied stages of development and a limited capacity for surges in demand. There was little evidence and a paucity of standardization methods for building healthcare facility/system resilience. This study provides policy recommendations for strengthening LMIC emergency care systems to protect lives and advance health equity.